Skin donation: Need of the hour

Dr Suhas Abhyankar, Consultant Plastic and Reconstructive Surgeon, Eric Kharas Burns Research Centre, Masina Hospital, talks about the need to create more awareness on skin donation, which can be a boon for patients with critical skin issues

The human skin is the largest organ in the human body. It shields us from harmful effects and enables us to mend itself from wear and tear. Loss of skin removes protective barrier against bacterial invasions and make the patient vulnerable to infections. However, when the skin damage is critical, measures like skin transplant is undertaken. We are mostly aware of blood, organ, cadaver and eye donations but lack awareness of skin donation. By donating skin, it provides a better quality of life for people suffering from severe burns and injuries. The donated skin is processed and stored in a skin bank before transplantation. An awareness about skin donation is the need of the hour in order to resolve one of the most perilous issues in medical science.

Generally, in the absence of a skin bank, doctors use the healthy skin of the patient by grafting it and reusing it in plastic surgery. However, this is a delayed recovery process. In today’s advanced infrastructure, skin banks is a boon in medical history, as patients do not require a match in blood group and the burn victims can be saved if a barrier is created by grafting new skin donated as ‘allografts’. Any person devoid of HIV, Hepatitis B or C, STDs (sexually transmitted diseases), Septicemia, skin cancers or skin diseases can also donate skin. ‘Allografts’ acts as a biological dressing thus helps in preventing infections, reduces pain and also gives mechanical protection. Thereby, accelerates the process of healing. This results in less scars, contractures and minimal permanent disfigurement.

The concept of skin donation after death is not a new process and the first skin bank was established in the US around 1950. Burn prevention is one of the major public health programmes around the world. Various studies shows that most people die due to burn injuries than other infectious diseases. Approximately, around 1, 20,000 to 1, 40,000 people die every year in India due to burns. Donation should be done within six to eight hours of donor’s death.

This long intensive process of skin transplantation is carried out by a team of dedicated doctors who initiate the lengthy procedure starting with the patient’s consent and verified documents, the team proceeds for harvesting various parts of the body. Only 1/8th thickness part of the skin is taken using a special instrument called Dermatome and the processed skin is stored at minus 80 degrees in a special storage freezer.

The donor skin and dermal grafts are used in several types of loss of substance for different clinical purposes. As a biological physiological medication, donor skin grafts can promote re-epithelisation, shorten healing time, alleviate pain and protect dermal and subcutaneous structures such as cartilage, tendons, bones and nerves. Though a variety of dermal matrices and skin equivalents, both synthetic and semi-synthetic, are available for wound treatment, viable human skin allografts remain an important therapeutic choice for extensive deep burns and hard-to-heal wounds. In such cases, viable skin allografts have significantly better clinical outcomes than unviable human-derived allografts or synthetic medications.

Skin banks

At a skin bank, skins grafts are available at subsidised rates which are of excellent quality, processed according to all international standards and utilised by plastic surgeons and also general surgeons, and orthopaedics. The new skin is used for burns patients, skin loss, diabetic non-healing ulcers, etc. where they act as an excellent biological dressing preventing protein, body fluids loss, pain relief, mechanical protection, thus helping in early recovery and reducing mortality and morbidity.

The demand for human-derived skin bio-products continues to be a reason for the existence of skin banks. Skin bank organisation is complex and requires continuous updating. Careful donor selection, thorough microbiological and serological donor screening for transmissible diseases and rigorous quality control during tissue preparation are necessary to minimise the risk of transmission of pathogenic agents. Skin banks must also observe standardised reproducible procedures to ensure tissue traceability and biological safety in all phases of processing and to avoid new biological contamination. Constant training and periodic checks are needed to keep skin bank operators attentive and responsible. Finally, skin banks should guarantee collection and storage of highly
viable skin.

A skin bank is similar to an eye bank. In India, at present, awareness about the concept of skin donation is poor. Despite doctors from various skin banks around different states are counselling relatives of patients who breathe their last, not many are coming forward to donate the vital and the largest human organ. India records around 70 lakh burn injury cases annually and of which 1.4 lakh people die every year. With generating right awareness, skin banks will play vital role in saving lives. The bank is a boon for patients as there is no blood group matching required in skin grafting. Anyone over 18 years, who does not have skin disease or infections, can donate skin. Masina Hospital, in a shot span of six months, has procured skin from more than 20 cadavers and almost half the procured skin has been utilised satisfactorily.